As Amended August 21, 2015.
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On review from the Iowa Court of Appeals. Appeal from the Iowa District Court for Webster County, Thomas J. Bice, Judge. Defendant appeals her conviction for murder in the second degree for the death of her newborn son.
DECISION OF COURT OF APPEALS VACATED; DISTRICT COURT JUDGMENT AFFIRMED IN PART AND REVERSED IN PART AND CASE REMANDED.
Mark C. Smith, State Appellate Defender, and Maria Ruhtenberg, Assistant Appellate Defender, for appellant.
Thomas J. Miller, Attorney General, Tyler J. Buller and Laura Roan, Assistant Attorneys General, and Ricki Osborn and Cori Kuhn Coleman, County Attorneys, for appellee.
ZAGER, Justice. Hecht, J., files a concurrence in part and dissent in part in which Wiggins and Appel, JJ., join. Appel, J., files a concurrence in part and dissent in part in which Wiggins and Hecht, JJ., join. Waterman, J., files a concurrence in part and dissent in part in which Cady, C.J., and Mansfield, J., join.
Hillary Tyler appeals her conviction for murder in the second degree for the death of her newborn son (Baby Tyler). See Iowa Code § § 707.1, .3 (2011). She maintains the district court erred in denying several of her trial motions, including: a motion in limine to exclude a medical examiner's testimony and autopsy report opining to the cause and manner of Baby Tyler's death, a motion to suppress evidence obtained by police during the search of Tyler's hotel room, and a motion to suppress statements Tyler made to police.
She also maintains there was insufficient evidence to support her conviction. The court of appeals held the district court abused its discretion in allowing the medical examiner to testify to the cause and manner of Baby Tyler's death and in admitting the unredacted autopsy report into evidence. Accordingly, it reversed the judgment of the district court and remanded the case for a new trial. The court of appeals did not address the remaining issues raised in the appeal.
The State applied for further review, which we granted. On further review, we conclude the district court abused its discretion in allowing the medical examiner to testify to the cause and manner of Baby Tyler's death because the medical examiner based his opinions primarily, if not exclusively, on Tyler's inconsistent and uncorroborated statements to the police as opposed to objective, scientific, or medical evidence. For the same reason, the district court should have redacted any reference to cause and manner of death in the autopsy report. Additionally, we conclude the district court erred in denying Tyler's motion to suppress evidence obtained by the police during the search of the hotel room based solely on the legal conclusion that Tyler had no reasonable expectation of privacy in the room because she obtained it for the purpose of committing a crime. Thus, we reverse this motion and remand the issue for further hearing and ruling by the district court concerning the applicability of exceptions to the warrant requirement or exclusionary rule. We affirm the district court's denial of Tyler's motion to suppress statements she made to police. We vacate the decision of the court of appeals, affirm the judgment of the district court in part and reverse in part, and remand the case for additional proceedings consistent with this opinion and a new trial.
I. Background Facts and Proceedings.
Tyler and Rodney Cyphers began dating in 2010. In early 2011, Cyphers noticed Tyler was beginning to exhibit signs of pregnancy and asked her if she was pregnant. Tyler denied being pregnant. She told Cyphers she was suffering from a medical condition that caused her to exhibit signs typically associated with pregnancy. Tyler was in fact pregnant. Over time, Tyler exhibited increased signs of pregnancy and began wearing looser fitting clothing. Even so, Tyler continued to deny she was pregnant to anyone who asked and refused to allow Cyphers to touch her abdomen.
In the summer of 2011, Cyphers's employer assigned him to a job at a plant located in Fort Dodge, Iowa. At the end of August, Tyler and Cyphers temporarily relocated to Coalville, Iowa, which is approximately ten miles south of Fort Dodge. While there, Tyler and Cyphers lived in a fifth-wheel trailer in a trailer park.
At approximately 3:00 a.m. on September 19, Tyler began experiencing mild contractions. At approximately 6:30 a.m., she called the Super 8 Hotel in Fort Dodge to inquire about a room. She spoke with the hotel manager who advised her that a room was available. Tyler arrived at the hotel approximately twenty minutes later and checked into room 225. Tyler occupied room 225 from approximately 6:50 a.m. until 4:30 p.m. At approximately 12:00 p.m., she gave birth to Baby Tyler in the bathroom of room 225. She then " laid around for a little bit" and " cleaned the bathroom floor" before returning to the trailer in Coalville. Cyphers was home when she arrived. Shortly before 7:00 p.m., Cyphers left to work a night shift.
Tyler stayed alone at the trailer for the night.
After working the night shift, Cyphers returned to the trailer at approximately 7:15 a.m. on September 20. Tyler was present when he arrived. The couple ate breakfast and ran a few errands before returning to the trailer so that Cyphers could sleep. At approximately 10:15 a.m., Tyler returned to the hotel to check out of room 225. Upon Tyler's arrival, the hotel manager informed Tyler there had been a cancellation and room 225 was available for an additional night. Another member of the hotel staff had previously informed Tyler room 225 was not available for an additional night. Tyler rented room 225 for the night of September 20. Shortly thereafter, she left the hotel and returned to the trailer in Coalville. She intended to return to the room later that evening to clean it further.
At approximately 11:00 a.m., a housekeeper at the hotel entered room 225 to clean it. Because Tyler had not rerented the room until late that morning, the sheet informing the housekeeper of the room's rental status had not been updated to reflect that the room was a " stayover" as opposed to a " checkout." The doorknob to the room had a " Do Not Disturb" sign hanging from it. Upon entering the room, the housekeeper observed the carpet was saturated with blood. Upon entering the bathroom, she further discovered " a lot of blood smear[ed] . . . on the floor." The housekeeper then exited the bathroom and discovered a " hoodie coat." She picked it up and observed the inside of the coat was saturated with blood. Additionally, she observed two discarded vodka bottles and " $8 . . . on the dresser by the TV," which she thought was a tip. She also observed a garbage can in the room, which contained a " white towel bundled up" among other trash. She " slid the garbage can" across the room and discovered it was " heavy." She did not empty the garbage can or further examine its contents. In a panicked state, she left the room and reported her findings to the hotel manager. The manager and the housekeeper returned to the room. Another housekeeper also entered the room " because she could tell there was something going on in the room." The other housekeeper " pulled the can liner out of the garbage can" and the group observed the towel in the garbage can had some blood on it and the bottom of the garbage bag contained " fluid and some blood." Although they did not see Baby Tyler's body, they were very concerned about the contents of the garbage can. The manager then called the police to report these findings.
Police were dispatched to the hotel at approximately 11:36 a.m. According to the responding officer, the original complaint " was for . . . criminal mischief . . . or . . . vandalism[,] . . . so that's what [he] was thinking going into it." Upon arrival at the hotel, the responding officer spoke with the hotel manager who advised him what the hotel staff had observed. Accompanied by hotel staff, the officer entered room 225 to investigate. Thereafter, he contacted his supervisor who arrived within approximately ten minutes. Over the next twenty to fifty minutes, the officers looked around the room as several additional officers arrived at the scene. In the course of their investigation, officers observed that, in addition to the blood, there appeared to be other bodily fluids present in the room. Eventually, one of the officers moved the towel and other items in the garbage can. Beneath these items, he discovered Baby Tyler's body. At that point, it " didn't appear that there was any need to render any aid," so the officers secured the room until they could obtain a search warrant.
After officers discovered Baby Tyler's body, Fort Dodge police contacted the Iowa Division of Criminal Investigation (DCI). Detectives from the Fort Dodge Police Department, in cooperation with the DCI, were subsequently able to identify and locate Tyler. At approximately 2:08 p.m., Special Agent Michael Roehrkasse of the DCI, Special Agent Ray Fiedler of the DCI, and Detective Jody Chansler of the Fort Dodge Police Department went to the trailer in Coalville. The officers were dressed in plain clothes as opposed to police uniforms. The officers approached the trailer and knocked on the door. Tyler answered. The officers' encounter with Tyler was audio recorded.
After making contact with Tyler, the officers told her they needed to speak with her. She told them she understood that she needed to speak with them. Detective Chansler asked Tyler if she needed any medical attention. She replied, " No." He then stated, " I want to have you go with this guy right here," and pointed to Special Agent Roehrkasse. He further stated, " We need to get to the bottom of what's going on." He then asked Tyler, " Are you okay with that?" Tyler responded, " Yea."
Tyler followed the officers to Special Agent Roehrkasse's vehicle and entered it. Outside of Tyler's presence, the officers discussed how Special Agent Roehrkasse should ask Tyler if the baby was born alive. Special Agent Roehrkasse then entered the vehicle and proceeded to drive to the Fort Dodge police station. He did not read Tyler her Miranda rights at this time. During the ride, Special Agent Roehrkasse asked Tyler if the baby had moved. She responded, " No." He also asked her if the baby had cried. She responded, " No." Special Agent Roehrkasse and Tyler did not discuss anything else of significance during the ride to the police station.
After arriving at the police station, Tyler was escorted to an interview room in the basement. Thereafter, Special Agent Roehrkasse, along with Special Agent Jim Thiele of the DCI, questioned Tyler over a period of approximately three hours. The interview was video recorded. Both officers were wearing guns on their hips. During the interview, the door to the room was closed; however, it was unlocked and Tyler's path to it was unobstructed.
Special Agent Roehrkasse began the interview by asking Tyler if she needed any medical attention. She responded, " No." He then informed her that although she had ridden with him to the police station, she was free to leave at any time. He also informed her that if she desired, he would drive her back to the trailer. He told her that although the door was shut, that should not deter her from leaving. During the interview, the special agents again reminded Tyler she was not in custody and was free to leave. The special agents twice suggested that Tyler seek medical treatment.
During the first half of the interview, the special agents asked Tyler open-ended questions about her background and the events surrounding Baby Tyler's birth. During this period, Tyler told the special agents that after Baby Tyler was born he was silent, he did not move, and she immediately placed him in the garbage can. After approximately forty-five minutes, the special agents took a forty-three minute break. Before they left the room, Special Agent Thiele reminded Tyler the door was unlocked and informed her that she was free to " get up and roam around" if she wanted. After the break, Special Agent
Roehrkasse returned alone, began asking Tyler more pointed questions about the birth, and posited several hypothetical questions about what the autopsy would show. Tyler eventually stated that after Baby Tyler was born he moved and cried and she placed him in the bathtub and turned the water on for the purpose of drowning him. Special Agent Roehrkasse then took another thirty-minute break before returning to ask Tyler several follow-up questions. Special Agent Roehrkasse then took another fifteen-minute break. Upon his return, he informed Tyler she would be " charged today" and read Tyler her Miranda rights. After waiving her Miranda rights by signing a written waiver form, Special Agent Roehrkasse reviewed Tyler's statements with her. Tyler confirmed that after Baby Tyler was born he moved and cried and she placed him in the bathtub and turned on the water for the purpose of drowning him. At the conclusion of the interview, the special agents took Tyler to the hospital for medical treatment.
Although the exact time is not clear from the record, officers filed an application for search warrant after they completed the interview at the police station. Through the warrant application, officers sought authorization to search for and seize items from room 225, a pickup truck registered to Cyphers, and the trailer in Coalville. Officers also sought to obtain DNA samples from both Tyler and Cyphers for analysis. In the warrant application, Detective Cory Husske wrote that at approximately 11:00 a.m. the Super 8 cleaning staff " found . . . room  in disarray," " saw what looked like blood in multiple locations around the room and bathroom," " observed a garbage can in the room containing towels soaked in blood and female menstruation pads," noticed the garbage can " had a heav[y] weight about it," and contacted police. The warrant application noted that after officers confirmed the information provided by the hotel staff and found Baby Tyler's body in the garbage can, they decided to " get as much information extracted from [the] room as [was] possible through the use of a search warrant." The warrant application explained the officers then sought to locate Tyler and, in cooperation with the DCI, were successful in doing so. Finally, the warrant application noted that officers had " obtained audio/video recorded statements from [Tyler] in which she . . . admitted to giving birth to a baby and discarding it." Officers subsequently seized a number of items from room 225, including Baby Tyler's body and a piece of the umbilical cord. Officers also seized a number of items from the trailer in Coalville, including the placenta.
After Tyler arrived at the hospital on September 20, Dr. Daniel Cole treated her and ordered several lab tests. He testified at the suppression hearing and at trial that Tyler was alert and aware of her surroundings when he was treating her. Thereafter, Tyler received surgical repair for a tear from childbirth. She had lost a large amount of blood and her blood pressure was high. She received a blood transfusion and several medications. Tyler
was also suffering from a condition called preeclampsia. This is a condition that occurs in pregnancy and causes the patient to become hypersensitive and leads to increased blood pressure.
The next day, September 21, Special Agent Roehrkasse and Special Agent in Charge Larry Hedlund of the DCI went to Tyler's hospital room to question Tyler again. This interview was audio recorded and lasted for approximately fifty minutes. At the start of the interview, Special Agent in Charge Hedlund read Tyler her Miranda rights. " [H]e went through each of [her rights] and had her explain what each of the rights meant to her." Tyler explained each of her rights back to the special agents in her own words. She acknowledged that she understood her rights and signed another written waiver form. Tyler told the special agents she was " really out of it." However, she remembered speaking with Special Agent Roehrkasse the previous day and that his name was " Mike." She also knew that she was at the hospital. Additionally, when the special agents asked Tyler if she would prefer " [they] come back later," Tyler responded, " You can talk to me." The special agents told Tyler that if she got too tired or upset, they would stop the questioning. During the questioning Tyler never appeared confused and was alert and tracking with the special agents' questions. During this follow-up interview, Tyler again stated that after Baby Tyler was born he moved and cried and she placed him in the bathtub and turned on the water for the purpose of drowning him.
Baby Tyler's body, a piece of the umbilical cord, and the placenta were taken to the offices of the State Medical Examiner. Thereafter, Dr. Jonathan Thompson, an Associate State Medical Examiner trained in the field of forensic pathology, performed an autopsy on Baby Tyler's body and a pathology examination on the body and related items. Dr. Thompson subsequently issued a " Report of Autopsy" summarizing his findings.
After performing the autopsy and pathology examination, Dr. Thompson's opinions on both the cause and manner of Baby Tyler's death were " Undetermined." In his final report, however, Dr. Thompson concluded the cause of death was " Bathtub drowning" and the manner of death was " Homicide." His final report indicated that in reaching these conclusions he performed both an external and internal examination of Baby Tyler's body. His report further indicated that in forming his opinions he relied on Tyler's statements to police. The report stated: " The mother claimed she had given birth the previous day in the motel room and then placed the infant in a bathtub partially filled with water shortly after the birth. The baby reportedly moved and cried after birth."
Based on Tyler's statements to police and other evidence obtained during the investigation, the State charged Tyler with murder in the first degree for the death of Baby Tyler on September 28. See Iowa Code § § 707.1, .2(1), .2(5). Tyler entered a plea of not guilty.
Prior to trial, Tyler filed several motions relevant to this appeal, including: a motion in limine to exclude Dr. Thompson's testimony and autopsy report opining to the cause and manner of Baby Tyler's death; a motion to suppress evidence obtained by police during the search of room 225 in violation of the Fourth Amendment to the United States Constitution and article I, section 8 of the Iowa Constitution;
and a motion to suppress Tyler's statements to police in violation of the Fifth and Fourteenth Amendments to the United States Constitution and article I, section 9 of the Iowa Constitution.
After hearings on the motions, the district court denied both of Tyler's motions to suppress. On the motion to suppress evidence obtained by police during the search of room 225, the district court concluded Tyler did not have a reasonable expectation of privacy in the room because she had not intended to use the room as a residence, but instead as a venue for the commission of an alleged crime. Thus, the district court concluded Tyler's Fourth Amendment rights were not implicated. On the motion to suppress Tyler's statements to police, the district court concluded Tyler was not in custody at the trailer, during the ride to the police station, or during the questioning at the police station on September 20. As a result, the district court concluded her Fifth Amendment rights were not violated. The district court also concluded the special agents' follow-up questioning of Tyler at the hospital did not violate her rights because the special agents informed her of her Miranda rights and she executed a knowing, intelligent, and voluntary waiver.
On January 15, 2013, the district court held a hearing on Tyler's motion in limine to address the admissibility of Dr. Thompson's expert opinion on the cause and manner of Baby Tyler's death. Tyler's motion requested that the district court " prohibit the State . . . from soliciting or introducing any evidence from [Dr. Thompson] on his conclusions of the truthfulness of [Tyler's] statements that were provided to him by law enforcement." Tyler maintained this evidence impermissibly " passe[d] on [her] guilt or innocence" and constituted an improper comment on her credibility. Tyler's motion also requested that the district court " prohibit the State . . . from soliciting or introducing any evidence from [Dr. Thompson] as to scientific or medical opinions on the cause or manner of death." Tyler maintained Dr. Thompson's opinion on these matters " would not be based on any scientific or medical knowledge, scientific standards, or technical training, but merely from the witness adopting the statements and conclusions of law enforcement."
At the hearing, Tyler's counsel questioned Dr. Thompson about the autopsy he performed and the foundation for his conclusions of the cause and manner of Baby Tyler's death. The following exchange occurred:
Q. Okay. So the examination includes your visual examination, both inside and outside of the body that you're examining, correct? A. Yes, sir.
Q. And then it also includes various . . . scientific tests? A. Yes, it does.
. . . .
Q. In this case, if you based your opinions speaking strictly on medical or scientific evidence, you were unable to give a conclusion as to whether or not this was a homicide, correct? A. Just on the autopsy findings, that would be correct, yes.
Q. Okay. And also based just on the autopsy findings, you would be unable to determine whether or not this was a drowning, correct? A. That would be correct, yes.
Q. The autopsy findings were consistent with intrauterine fetal demise, correct? A. They could be, yes.
Q. They could also be consistent with a baby that died immediately after birth, correct? A. It could be, yes.
. . . .
Q. Okay. So the specific autopsy, the testing that you did, the toxicology test, the examination of the lungs, all of the things you did, the examination of the stomach contents, all of that led you to an inconclusive determination, correct? A. That's correct, yes.
Q. And the only way that you reached the conclusion of homicide as the manner of death, as drowning as a cause of death, is through observing and watching the videotapes that the law enforcement officers supplied to you, correct? A. Yes, it is.
Q. So that would be of Miss Tyler's interview with the police, correct? A. That's correct.
. . . .
Q. Okay. So from that standpoint, ultimately your opinion as to whether or not this was a homicide . . . and what the cause of death was, is based entirely on your belief of her statements, correct? A. That's correct, yes.
. . . .
Q. Okay. . . . [E]ssentially what you're saying is that since the autopsy didn't disprove her statement, you're going to believe her statement? A. That's correct, yes. There's nothing inconsistent between what she said and what I saw at the autopsy.
Q. Hypothetically speaking, if her statement to the police was the baby was a stillborn, your conclusion then would have had to have been stillborn birth, natural cause of death, correct? A. . . . I would probably classify as [stillbirth].
. . . .
Q. And that's just because the actual medical examination, medical testing, scientific testing is inconclusive? A. That's correct, yes.
The district court overruled Tyler's motion in limine. In its ruling, it noted that " in Iowa, the courts are committed to a liberal rule on the admission of expert testimony" and that Dr. Thompson's reliance on Tyler's statements to police was " no different than a physician relying on a patient's history in reaching a diagnosis." Consequently, the district court overruled Tyler's motion in limine, " subject to [her] right to vigorously and thoroughly cross-examine" Dr. Thompson. Trial in this matter commenced on February 11. The central issue in the case was the cause of Baby Tyler's death. Specifically, whether Baby Tyler was born alive and survived for a sufficient period for Tyler to drown him, or whether he was stillborn or died immediately after birth such that Tyler could not drown him. The State presented, among other evidence, testimony from Cyphers, members of the hotel staff, officers who investigated room 225, and the special agents who interviewed Tyler. The State also presented Tyler's interviews at both the police station and the hospital by way of video and audio recordings, respectively.
Dr. Thompson also testified on behalf of the State. On direct examination, he explained to the jury that the autopsy he conducted on Baby Tyler involved both an external and internal examination of the body. He explained that he found fluid in Baby Tyler's lungs. However, he also explained that this fluid was, at least in part, amniotic fluid. Dr. Thompson testified that because amniotic fluid is in part composed of water, there was no scientific basis for determining whether some of the fluid was bathwater. Dr. Thompson further testified that there were indications Baby Tyler may have taken a breath because the alveoli in the lungs were partially, although not entirely, expanded. He then testified that based on this finding, and " [g]iven the history that Baby Tyler cried and moved, . . . Baby Tyler probably took a few breaths." Dr. Thompson further testified that based on his findings, he was able to rule out several possible alternative causes of death. He then opined that Baby Tyler's cause of death was " drowning," and that his manner of death was " homicide" --meaning " death at the hands of another individual." Finally, Dr. Thompson testified that his opinions on the cause and manner of Baby Tyler's death were based on " a combination of history, which includes scene findings, it includes witness statements; it's also based on a combination of physical exam, which is [the] autopsy findings; and then supplemental testing."
On cross-examination, defense counsel called attention to the inconclusive nature of Dr. Thompson's autopsy findings. Counsel asked Dr. Thompson if there was an alternative explanation for the partially expanded alveoli in Baby Tyler's lungs. Dr. Thompson explained that partially expanded alveoli would also be consistent with the production of methane gas by bacteria found in the body after death, which " will diffuse up into the lungs and can expand those a[l]veolar spaces." Counsel also questioned Dr. Thompson as to whether it was possible, based on the autopsy, that Baby Tyler was stillborn or died immediately after birth. Dr. Thompson testified there were several other possible causes of death he could not rule out based on the autopsy findings alone. He agreed with defense counsel that it was possible Baby Tyler died either in utero or immediately after birth. Defense counsel and Dr. Thompson also had an exchange in which counsel pressed Dr. Thompson on the basis for his conclusion of the cause and manner of Baby Tyler's death. The following exchange occurred:
Q. Okay. It is true that you cannot say from your autopsy alone that the child in this case ever took a breath, correct? A. That's correct, yes.
Q. . . . For that opinion, you are entirely relying on the review of the interview in this case; is that correct? A. Uh, not necessarily, because there's nothing inconsistent with what the witness statement said with the autopsy findings.
Q. Well -- A. But without the witness statements, I could not have diagnosed drowning in this case.
Q. You had conducted your autopsy, correct? A. Yes.
Q. Your opinion was undetermined at that time? A. That's correct, yes.
Q. And then the only way you came up with your decision in this case was based on the interview you watched? A. Yes, sir, that's correct.
Q. Now, you're relying on the fact that [Tyler] said prior to putting the baby in the tub, the baby moved and cried, correct? A. Yes, sir.
Tyler's defense was that her statements to police were not credible and the product of coercion. Counsel noted that during the
first half of the interview at the police station, Tyler denied the baby cried or moved after the birth. It was only after being interviewed for forty-five minutes and a forty-three minute break that Tyler stated the baby cried and moved. Tyler maintained these statements were not credible due to the length of the interview and her need for medical care. As to her second interview at the hospital, Tyler's defense was that these statements were also not credible due to her medicated and vulnerable state. Tyler also presented a medical expert who testified in her defense. This pathologist testified that there was not sufficient information to determine the cause or manner of death.
The jury found Tyler guilty of the lesser included offense of murder in the second degree. See Iowa Code § § 707.1, .3. Tyler appealed and we transferred the case to the court of appeals. The court of appeals held the district court abused its discretion in allowing Dr. Thompson to testify to the cause and manner of Baby Tyler's death and in admitting the unredacted autopsy report into evidence. The court of appeals reasoned Dr. Thompson's reliance on Tyler's statements in forming his opinions on the cause and manner of death amounted to an improper comment on Tyler's credibility. It also concluded Dr. Thompson's opinions could not fairly be characterized as expert medical opinions. The court of appeals further determined the erroneous admission of Dr. Thompson's testimony and autopsy report into evidence was reversible error because Tyler's credibility was the central issue in the case. The court of appeals reversed the conviction and remanded the case for a new trial. It did not address the remaining issues raised in the appeal.
The State applied for further review, which we granted. We will provide additional facts in the discussion of specific issues below.
II. Standard of Review.
Evidentiary rulings are reviewed for an abuse of discretion. State v. Elliott, 806 N.W.2d 660, 667 (Iowa 2011). " 'An abuse of discretion occurs " when the district court exercises its discretion on grounds or for reasons clearly untenable or to an extent clearly unreasonable." '" State v. Miller, 841 N.W.2d 583, 586 (Iowa 2014) (quoting Rowedder v. Anderson, 814 N.W.2d 585, 589 (Iowa 2012)). " 'A ground or reason is untenable when it is not supported by substantial evidence or when it is based on an erroneous application of the law.'" State v. Redmond, 803 N.W.2d 112, 117 (Iowa 2011) (quoting Graber v. City of Ankeny, 616 N.W.2d 633, 638 (Iowa 2000)). " Thus, under our abuse-of-discretion standard, 'we will correct an erroneous application of the law.'" Miller, 841 N.W.2d at 586 (quoting Rowedder, 814 N.W.2d at 589). " '" When the error is not of constitutional magnitude, the test of prejudice is whether it sufficiently appears that the rights of the complaining party have been injuriously affected or that the party has suffered a miscarriage of justice." '" Id. (quoting State v. Marin, 788 N.W.2d 833, 836 (Iowa 2010)).
We review determinations of whether to suppress both evidence obtained and statements made in violation of constitutional guarantees de novo. State v. Watts, 801 N.W.2d 845, 850 (Iowa 2011); State v. Palmer, 791 N.W.2d 840, 844 (Iowa 2010). " [W]e make '" an independent evaluation of the totality of the circumstances as shown by the entire record," '" considering " both the evidence introduced at the suppression hearing as well as the evidence introduced at trial." Palmer, 791 N.W.2d at 844 (quoting State v. Turner, 630 N.W.2d 601, 606 (Iowa 2001));
see also Watts, 801 N.W.2d at 850. " 'We give deference to the district court's fact findings due to its opportunity to assess the credibility of witnesses, but we are not bound by those findings.'" Palmer, 791 N.W.2d at 844 (quoting Turner, 630 N.W.2d at 606). In considering whether a defendant's statements were voluntarily given, we give considerable weight to the district court's findings. State v. Payton, 481 N.W.2d 325, 328 (Iowa 1992). When the alleged error concerns the erroneous admission of evidence in violation of a defendant's constitutional rights, such error is typically subject to harmless-error analysis. See State v. Peterson, 663 N.W.2d 417, 430 (Iowa 2003).
III. Discussion of Medical Examiner Testimony.
In our analysis of this case, we must determine when medical examiners may rely on witness statements and the results of police investigations, in addition to their medical examination and findings, in forming their opinions on cause or manner of death. We begin by setting forth the role of expert testimony within our system of justice. Next, we consider the duties and responsibilities of our state medical examiners. We then consider whether medical examiners may rely on witness statements and information obtained through police investigations in forming their opinions on cause or manner of death. Finally, we consider whether under the unique circumstances of this case, it was appropriate for Dr. Thompson to opine on the cause and manner of Baby Tyler's death.
A. The Role of Expert Testimony in Iowa.
Iowa is generally " committed to a liberal view on the admissibility of expert testimony." Ranes v. Adams Labs., Inc., 778 N.W.2d 677, 685 (Iowa 2010). Iowa Rule of Evidence 5.702 allows expert opinion testimony " [i]f scientific, technical, or other specialized knowledge will assist the trier of fact to understand the evidence or to determine a fact in issue." Iowa Rule of Evidence 5.703 provides further insight into the information experts may rely on in forming their opinions. This rule provides:
The facts or data in the particular case upon which an expert bases an opinion or inference may be those perceived by or made known to the expert at or before the trial or hearing. If of a type reasonably relied upon by experts in the particular field in forming opinions or inferences upon the subject, the facts or data need not be admissible in evidence.
Iowa R. Evid. 5.703.
" [T]here is no requirement that the expert be able to express an opinion with absolute certainty. A lack of absolute certainty goes to the weight of the expert's testimony, not to its admissibility." Johnson v. Knoxville Cmty. Sch. Dist., 570 N.W.2d 633, 637 (Iowa 1997) (citation omitted). In the context of cause of death determinations, in order to be considered by the trier of fact " 'it is only necessary that the witness entertain a " reasonable degree of medical certainty" for his conclusions.'" State v. Webb, 309 N.W.2d 404, 413 (Iowa 1981) (quoting Commonwealth v. Stoltzfus, 462 Pa. 43, 337 A.2d 873, 879 (Pa. 1975)). " '" Whether the . . . evidence is sufficient to warrant a finding of causal connection is initially a legal question for the court, but whether it is persuasive beyond a reasonable doubt is for the jury to say." '" Id. at 413-14 (quoting Stoltzfus, 337 A.2d at 879).
" [O]therwise admissible [opinion testimony] is not objectionable because it embraces an ultimate issue to be decided by the trier of fact." Iowa R. Evid. 5.704. However, an expert may not opine as to whether a particular legal standard has
been satisfied or to " the defendant's guilt or innocence." State v. Smith, 522 N.W.2d 591, 593-94 (Iowa 1994). Further, we have continually held that expert testimony is not admissible merely to bolster a witness's credibility. See State v. Dudley, 856 N.W.2d 668, 676 (Iowa 2014) (" [W]e continue to hold expert testimony is not admissible merely to bolster credibility." ); State v. Myers, 382 N.W.2d 91, 97 (Iowa 1986) (" [M]ost courts reject expert testimony that either directly or indirectly renders an opinion on the credibility or truthfulness of a witness." ). As we recently explained with respect to this rule:
Our system of justice vests the jury with the function of evaluating a witness's credibility. The reason for not allowing this testimony is that a witness's credibility " is not a 'fact in issue' subject to expert opinion." Such opinions not only replace the jury's function in determining credibility, but the jury can employ this type of testimony as a direct comment on defendant's guilt or innocence. Moreover, when an expert comments, directly or indirectly, on a witness's credibility, the expert is giving his or her scientific certainty stamp of approval on the testimony even though an expert cannot accurately opine when a witness is telling the truth. In our system of justice, it is the jury's function to determine the credibility of a witness. An abuse of discretion occurs when a court allows such testimony.
Dudley, 856 N.W.2d at 676-77 (citations omitted) (quoting State v. Hulbert, 481 N.W.2d 329, 332 (Iowa 1992)). Notwithstanding, " [w]e recognize there is a very thin line between testimony that assists the jury in reaching its verdict and testimony that conveys to the jury that [a witness's] out-of-court statements and testimony are credible." Id. at 677.
B. The Role of the Medical Examiner.
A state medical examiner must be " a physician and surgeon or osteopathic physician and surgeon, . . . licensed to practice medicine in the state of Iowa, and . . . board certified or eligible to be board certified in anatomic and forensic pathology by the American board of pathology." Iowa Code § 691.5. Forensic pathologists are physicians who specialize in forensic pathology, meaning they received a Doctor of Medicine or a Doctor of Osteopathy, spent at least four years in a residency program, and then spent another year in a forensic pathology fellowship. See Iowa Code § 331.801(2) (outlining requirements to serve as a county medical examiner); id. § 691.5 (outlining requirements to serve as a state medical examiner); David Dolinak et al., Forensic Pathology: Principles and Practice, at xxiii (Mark Listewnik et al. eds., 2005) [hereinafter Dolinak] (outlining qualifications of forensic pathologists). In certain cases, state law requires medical examiners to investigate the cause and manner of a death, conduct an autopsy, and prepare a written report of their findings. See Iowa Code § 331.802(2)( a ) (requiring county medical examiners to " conduct a preliminary investigation of the cause and manner of death [and] prepare a written report of the findings" when " a person's death affects the public interest" ); id. § 691.6(7)-(8) (requiring the state medical examiner to " perform an autopsy or order that an autopsy be performed" if required by law and to " retain tissues, organs, and bodily fluids as necessary to determine the cause and manner of death" ); Iowa Admin. Code r. 641-127.3(1), (5) (requiring county medical examiners to " perform an autopsy or order that an autopsy be performed" in specified cases and submit a " complete record of the findings of the autopsy . . . to the state medical examiner's office" ).
The administrative code defines " Cause of death " as " the disease or injury which sets in motion the chain of events which eventually result in the death of a person." Iowa Admin. Code r. 641-127.1. The administrative code defines " Manner of death " as " the circumstances under which the cause of death occurred." Id. The manner of death " may be specified as . . . natural, accident, suicide, homicide, undetermined, or pending." Id. In this context, and as explained by Dr. Thompson at trial, the term " homicide" means " [t]he killing of one human being by . . . another." Black's Law Dictionary 734 (6th ed. 1990). The term " homicide" expresses no opinion as to the criminality of the killing or the culpability of the killer. See id.
In making cause and manner of death determinations, medical examiners conduct an autopsy, defined as " the external and internal postmortem examination of a deceased person." Iowa Admin. Code r. 641-127.1; see Iowa Code § 691.6(7); Iowa Admin. Code r. 641-127.3(1). Further, in making these determinations, medical examiners routinely rely on the circumstances that surround the death, as revealed by independent investigation, police investigation, and eyewitness accounts. See Iowa Code § 691.6(5) (" The duties of the state medical examiner shall be: To conduct an inquiry, investigation, or hearing and administer oaths and receive testimony under oath relative to the matter of inquiry, investigation, or hearing, and to subpoena witnesses and require the production of records, papers, and documents pertinent to the death investigation." ); Dolinak at 4 (" Before the autopsy is interpreted, circumstances prior to death must be considered." ); Michael J. Shkrum & David A. Ramsay, Forensic Pathology of Trauma: Common Problems for the Pathologist 2 (2007) (" A complete autopsy requires the integration of information from various investigative sources . . . ." ).
C. Reliance on Witness Statements and Information Obtained Through Police Investigation.
Whether a medical examiner may opine on cause or manner of death when his or her opinions are based largely on uncorroborated witness statements or information obtained through police investigation is an issue of first impression in Iowa. Other jurisdictions that have considered the issue have failed to reach a consensus. State v. Sosnowicz, 229 Ariz. 90, 270 P.3d 917, 923-24 (Ariz. Ct.App. 2012) (collecting cases and noting that " [t]o the extent that there is a common thread amongst these cases, it is that the admissibility in a criminal case of a medical examiner's opinion regarding the manner of death depends on the particular facts and circumstances of each case" ). We turn now to survey the authority on the issue.
As discussed above, expert opinion testimony is admissible " [i]f scientific, technical, or other ...